Western Europe: The Middle Ages Western Europe: The Middle Ages By Albert S. Lyons | Medical History | Rating: Western Europe emerged from the Dark Ages about the year 1000 in a spirit of enthusiasm, optimism, and cultural unity difficult for us to understand today, given our knowledge of the horrors, plagues, famine, war, and instability with which the Middle Ages came to an end nearly five centuries later. But in the year 1000 the future appeared bright. French culture, with its combination of faith, feudalism, and chivalry, progressively gave forth a model upon which European civilization was to be patterned, while the Mediterranean world was in temporary disarray. Medieval philosophers, after a period of oscillation between Platonic concepts of transcendent universals (such as "Good" and "Beauty") and Aristotelian denials of their existence, ultimately sided with Aristotle, especially as interpreted by the Arabists. To them the only reality was individual reality, and the world was a pluralistic collection of individuals and particulars.

Drawing upon Boethius (the Roman philosopher and translator of Aristotle through whose work Greek philosophy was transmitted to the early Middle Ages), the medieval philosopher encouraged all to "be yourself�for your personality belongs only to you!" Partly because of this strong tendency toward individuality, the rigid social stratification of a feudal society gained support, for each person had his appropriate function and position. The Role of the Church By the year 1200 the mendicant teaching orders of the Dominicans and Franciscans had assumed control of the intellectual life of Paris, and, as before, the Church remained a conduit for personal advancement, even in a feudal society. The first great thinker belonging to the regulares (members of a holy order living by a Rule; in contrast to the seculares) was St. Albertus Magnus (1193?-1280), who assimilated much of the Aristotelian thought imported from the borderlands of Western Christendom: Spain, Sicily, and Byzantium. The traces of neoplatonism which had survived among the Byzantine and Islamic successors of Hellenistic civilization fared poorly in Western Europe, where, nevertheless, virtually all intellectual activity remained deductive.

Near the end of the thirteenth century, Albertus Magnus's pupil St. Thomas Aquinas (1225-74) had formulated Aristotelian thought so thoroughly that it was impregnable throughout the remainder of the Middle Ages. His refusal to believe that nature abounds in unnecessary things anticipated the pronouncement of William of Occam (1300?-49) that the simplest explanation should be applied to observed natural phenomena. Having based his strongest reliance upon the eternal nature of being (essentia), Aquinas was forced to utilize a sophisticated system to explain the changes often observed in the natural world. In the same way that an acorn's nature is to become an oak, many substances have inherent potency to become something else; thus their essence would not really change but merely be fulfilled. Since no being could will itself a change for which it had no potential, all other changes must derive from some outside influence. It was here that Aquinas fell back on theology: God was the prime mover who became the ultimate source of all change in the natural world�other than the above inherently potential becoming.

This doctrine of efficient causation�which became the cornerstone of Aquinas's system, known as Thomism or Scholasticism�gave the supernatural supremacy over the natural, but by implication the natural and supernatural worlds were separate if not independent. Although the brilliant synthesis of Scholasticism was to stultify independent thought during the Middle Ages, by the time Renaissance thinkers came to deny at least ordinary supernatural intervention in the natural world the foundations for the architecture of modern science had already been laid. The earlier philosophical oscillation between a pluralistic world and one of transcendent universals also had relevance to medieval man, so that the idea of individual nation-states stood in marked contrast for him to the universality of Christendom. This discord was felt most devastatingly in Germany and Italy, where the confrontation of Holy Roman Emperor and Pope ultimately damaged both. Only on the periphery of the continent, and most notably in France, England, and Spain, was the king (or nation) able to assert authority over the Church, though only after long and bitter struggle. Individual loyalties were horizontal as well as vertical, and, in the face of an expanding Islamic world, Europe had to assume a common identity in Western Christendom.

In spite of growing nationalism and the development of national languages, kings addressed each other in Latin as "brother," and the rules of chivalry maintained a common bond among the nobility of different countries. However, the Church of Rome was even more capable of crossing state lines, retaining sole authority over all who had taken holy vows. The growing power of the monastic orders led more directly to Rome than the legendary roads of the ancient Empire. Physicians and the Guilds In spite of a more ordered system of trade during most of the medieval period, European society remained isolated and rural, based largely on a local agricultural economy. Only the royal and noble courts were mobile, of necessity to maintain control over their vassals. Physicians trained in the universities were available only to the higher ranks of society, and for them entrance into holy orders and celibacy were generally mandatory, although, ironically, Jewish physicians (with freer access to Arabic medicine) became increasingly popular among heads of state and even popes. The masses, however, continued to rely on folk-healers, as well as barber-surgeons and teeth-pullers. Childbirth, a dangerous time for all women until the recent past, remained in the hands of midwives.

Even when serious problems arose and doctors were called in, women still remained as intermediaries. In contrast to the complex medicinal formulations of trained physicians, folk-healers relied on simpler concoctions and rudimentary magic. With the growth of cities in the twelfth and thirteenth centuries, there was an increase in the number of apothecaries setting up shop and preparing medications on their own as well as under direction of physicians. Their shops at times were meeting places for doctor and patient, but perhaps were frequented as often for astrological consultation and alchemy. During the Middle Ages, throughout Europe, men in the same crafts and professions banded together for mutual support and to promote high standards. The old separation of surgeons from other medical practitioners was reinforced and extended by the formation of guilds which were mutually exclusive. This custom was not solely a result of the academics' disdain for surgery but derived from the medieval tendency for crafts to be drawn together by the similarity of their tools and materials rather than the purpose for which they were used.

Thus, surgeons' guilds admitted barbers, and physicians were allied to apothecaries and, surprisingly, to artists because of their common use of powders (as pigments for the latter in water-, egg-, and, much later, oil-based paints). The common guild of artists and physicians may have been a significant factor during the early Renaissance in the great advances in knowledge of human anatomy, a subject of great interest to both groups. Even though the Church retained control of the universities throughout the Middle Ages, monastic medicine declined rapidly, but only in part because of people's growing interest in receiving earthly rather than heavenly rewards. In the twelfth and thirteenth centuries, control of hospitals and infirmaries was transferred from the Church to municipalities by mutual agreement. From this time date the origins of some of the great hospitals in Europe: the Hotel-Dieu in Paris, Santo Spirito in Rome, and St. Thomas's and St. Bartholomew's in England. The Crusades Ironically, at the same time that church councils were forbidding the practice of medicine to those monastic orders once the mainstay of Europe, newer nursing and hospital orders were developing.

The stimulus to the founding of these orders was not the need for medical care by indigenous populations but, rather, the Crusades, which ostensibly attempted the return of the Holy Land to Christian control. The Order of the Knights of the Hospital of St. John of Jerusalem, or Hospitalers, was founded in 1099. The order of the Knights of the Temple of Solomon (or Templars) and the Order of Lazarus (which was devoted to the care of lepers) were founded at the start of the twelfth century, while the Order of Teutonic Knights and the Order of the Holy Ghost were established somewhat later. These are only the most famous of a large complement of orders associated with the Crusades, and their later histories diverged widely. The Hospitalers looked after victims of the many epidemics which, we shall see, resulted in no small part from diseases brought home by returning Crusaders. The Templars, which became an increasingly military order, were ultimately subdued by the French state. The Teutonic Order, begun as a field hospital during the siege of Acre in the Third Crusade and approved by Pope Clement III in 1191, was influential in the establishment of formalized medical care in the German lands.

Papal approval of the Order of the Holy Ghost (Santo Spirito) led to the founding of a hospital not only in Rome but in nearly every city of Europe. Many other Catholic hospitals were founded throughout Europe, but, unlike their monastic forebears, were almost never independent of the municipalities they were intended to serve. The Crusaders brought home many things in addition to hospital orders. Exposure, especially of common soldiers, to the sophisticated and sensuous East created a material demand which simple piety was unable to squelch, and a flourishing trade with the East, mostly via Venice and Genoa, was quickly established. Nor did the more elaborate pharmacology of the Islamic East go unnoticed; new medical concoctions and sugar-based syrups began to appear in Europe for the first time. Leprosy and the Plague Disease, however, was the most significant import to Europe resulting from the Crusades. Throughout the period of the declining Roman Empire and the Dark Ages, leprosy was endemic at low levels in Western Europe, but after the Crusaders began streaming back home the number of lepers increased tremendously.

During the Middle Ages, the stigma of leprosy was not restricted to the disease as we know it today but was applied to a variety of dermatologic diseases, only some of which had any degree of contagiousness. Nevertheless, all individuals called lepers were subjected to total ostracism from society, which was stringently enforced by governmental and ecclesiastical authorities, as in Biblical times. Distinctive clothing was mandatory, as was segregation in places of public assembly, even worship. However, the Order of Lazarus was so sympathetic to the care of lepers that Lazarhouse quickly connoted leprosarium, and thousands were soon built throughout Europe. Many other contagious diseases were introduced into Europe by returning Crusaders. In spite of an elaborate system of hospices, travel in the medieval period remained arduous and risky; shipwreck, marauding brigands, and poor food added to the physical rigors. Epidemics of typhus, smallpox, and other diseases can be directly traced to returning Crusaders, but by far the most notorious epidemic to be imported from the East was that of the Black Death or bubonic plague.

Although plague had been known intermittently in Western Europe since ancient times, its reappearance in the mid-fourteenth century was dramatic and devastating. In the year 1347, the plague rapidly moved westward across India and southwest Russia. The city of Caffa (present-day Feodosiya), in the southeast Crimea, was besieged by fierce Tartars and appeared to have been saved when the invaders were slaughtered by the plague. However, to disastrous effect, the departing Tartars catapulted corpses of soldiers who had died of plague into the city. (They, too, seemed to understand the meaning of contagion). The Christian defenders may have won the day, but in traveling home nearly all died at sea. Those who did reach Italy started an epidemic which quickly spread throughout Europe (as far away as Greenland), and within a year as much as a quarter of the population of all Europe was stricken. In Marseilles, four-fifths of the inhabitants were claimed within months.

Ten years after the plague struck Florence, a superb description was given by Giovanni Boccaccio, author of the Decameron: In the year of our lord 1348, in Florence, the finest city of all Italy, there occurred a most terrible plague: either because of the influence of the planets or sent from God as a just punishment for our sins, it had broken out some years earlier in the East, and after passing from place to place and wreaking incredible havoc along the way had now reached the West where, in spite of all the means that art and human foresight could suggest, such as keeping the city clear from filth, and excluding all suspected people... Different from what it had been in the East, where bleeding from the nose suggests a fatal outcome, here there appeared tumors in the groins or under the armpits, some as big as a small apple, others like an egg. Afterwards purple spots appeared in most parts of the body... the usual messengers of death.

To the cure of this disease, neither the knowledge of medicine nor the power of drugs was of any effect, whether because the disease was itself fatal or because the physicians, whose number was increased by quacks and woman pretenders, could discover neither cause nor cure, and so few escaped. They generally died the third day after the appearance without fever... The disease grew daily by being communicated from the sick to the well... Nor was it [necessary] to converse or even to come near the sick; even touching their clothes or anything they had touched was sufficient... The events and similar others caused various fears among those people who survived, all tending to the same cruel and uncharitable end which was to avoid the sick and everything that had been near them... Some felt it best to live temperately... but others maintained free living and would deny no passion or appetite they wished to gratify... And the public distress was such that all laws, whether human or divine, were ignored... [emphasis added]. Although in typical medieval fashion Boccaccio could not decide between astrological events or divine displeasure as the root evil, he and his society recognized the contagious nature of plague.

He obviously also knew that in the East plague was primarily confined to the lungs (pneumonic) and not the lymph glands (bubonic) as in the West. The general dissolution of societal restraints that resulted from total frustration and impotence in the face of forces beyond control is obvious. Throughout Europe, physicians, when available, protected themselves in elaborate garb and masks with pointed beaks in which they kept vinegar and sweet-smelling potions to counteract the stench of draining buboes and decaying bodies. In Ragusa (modern Dubrovnik), across the Adriatic from Venice, all immigrants were obliged to stay in isolation for thirty and later forty days, giving rise to the term quarantine (from "quaranta," Italian for forty). Though by all standards the worst, the Black Death was only one of many severe epidemics to traverse Europe in the fourteenth and fifteenth centuries. In 1485 a new disease characterized by severe sweating appeared in England. Known as sudor anglicus, it brought death within days. Ironically, it was strong men who were struck down while old women and children were generally spared.

A short time later, outbreaks of the "sweating sickness" appeared in northern Europe, killing many, and, surprisingly, it suddenly vanished forever. Had contagion been the only affliction to hit Europe at the end of the Middle Ages, things would have been bad enough, but as a result of the Crusades, a growing nationalism, and an influx into the cities, societal controls were already loosening when the Black Death struck. Boccaccio's description of the total collapse of society at the height of the plague eloquently speaks for itself. Afterward, as a markedly reduced population attempted to reconstruct itself, despair and dissolution could hardly be dispelled overnight. Famines were unusually common, and a malnourished populace was subject not only to decreased resistance to disease but also to social unrest. The tremendous strains upon nearly all the people of Europe at the close of the Middle Ages were more severe on the general population than we can easily imagine. Lacking faith in all institutions, governmental or ecclesiastic, and lacking a tradition of individual closeness with their God, many people, often in desperation, gave up entirely or thrust their futures into the hands of new intercessors. Quacks abounded.

Astrology and black magic, always popular, became even more necessary to the confused and terrified masses. Pilgrimages crisscrossed Europe in hopes that certain saintly relics or special blessings of holy water might be the particular mediator of salvation. And yet, could anyone be certain of salvation? The Saints God, whose wrath was only too obviously expressed in disease, pestilence, famine, and civil strife, reassumed the stern visage of the Old Testament Jehovah. As the danse macabre became a subject of artistic presentation (especially in the countries north of the Alps), even Christ was depicted more often at the Last Judgment than as the Gentle Shepherd looking after his flock. Cults of the Virgin sprang up in hopes of gaining intercession with her son. Whereas in the Dark Ages intercession had been sought from those saints who were physician-martyrs of the early Church, in the Middle Ages there was a virtual explosion of cults devoted to all kinds of saints who might help cure diseases. Some, like St. Elizabeth and St. Roch, were famous for establishing healing centers or for providing medical care during their lifetimes.

The popularity of these two wellborn saints was reinforced not only by the many miraculous cures attributed to them but also by their rejection of exalted station for an ascetic life of devotion to the poor and downtrodden. Elizabeth dared to treat lepers, and Roch (or Rocco, as he is known in Italy) cared for the even more dreaded victims of the plague. There are many other examples. Most saints gained popularity during the decline of the medieval period. In contrast to physician-martyrs like Cosmas and Damian, the newer saints were increasingly associated with relief from a single disease or condition. A high degree of localism existed, and the connection of a saint to a given disease or part of the body often seems tenuous: St. Teresa of Avila was the protector of cardiac victims because an angel had shot an arrow into her heart. At times even the individual solace offered by the Church was insufficient, and loss of emotional balance among the people of the Middle Ages led to mass panic, frenzy, and hysteria.

Processions of flagellants traversed Europe with the firm conviction that their lashings reflected punishments decreed by God and foretold not only the dissolution of society but even the end of the world in the dread Day of Judgment. Another form of mass hysteria was a dancing madness called St. Vitus's dance, especially common in the German countries: men and women, generally peasants, would form circles and dance round and round frantically as if possessed until they fell to the ground, senseless and foaming at the mouth. Some historians consider the two disastrous "Children's Crusades" as further examples of mass hysteria. Doctors and Treatment The major developments during the Middle Ages in medical disciplines were the regulation of physicians' training and organizations, the development of ideas of contagion and policies of public health, and the establishment of ongoing institutions to provide care, if not cure, for the hopelessly ill, aged, or unwanted. The general populace had little contact with physicians. Thirteenth-century Paris had only a half dozen doctors in public employ, with little time to spend on individual patients. Even in northern Italy and the southern German countries, where physicians were more numerous, it was rare for a sick person to have a continuing therapeutic relationship with a doctor.

The distinction "doctor" in the Middle Ages was restricted to those with high rank and academic connections who spent more time thinking about disease in philosophical terms than in providing care. When supplied with the particulars of a difficult situation, the doctor would compose a consilium, generally at a high fee, but was rarely called upon to carry out his advice. In part, this derives from the later classical period when work with one's hands was considered distinctly inferior to that of the intellect. Diet was thought extremely important in the treatment of illness, and prescriptions would cover the minutest of details for all sorts of conditions. Perhaps greatest general reliance was placed on broths, milk, and eggs; milk alone was given especial importance in the treatment of consumption. Drugs were used heavily throughout the Middle Ages, and virtually any source might be tapped at one time or another. Plant materials were most often used in the preparation of digestives, laxatives, emetics, diuretics, diaphoretics, styptics, and the like. The most frequently used medication was theriac, which was developed in the ancient world and utilized many ingredients (one of which was viper flesh, thought especially effective against poisons).

Numerous imitations, like orvietan, were also used. Mysticism became more prevalent during the Middle Ages, even as the sciences were more heavily utilized in the development of concepts and treatment of various disease states. Symbolic procedures were thought important not only when used alone (as in the saying of an appropriate chant in the presence of a diseased individual) but even in the preparation of drugs or during surgery. Astrology was also given great weight. Furthermore, with increasing frequency during the later Middle Ages possession by devils was thought to be causally related to specific illness, generally, though not always, with psychological manifestations. For this, only one remedy could possibly be beneficial: exorcism by a priest. Mysticism, however, was extended to many other aspects of medical care. Amulets were commonly used to ward off spirits, and animal parts, especially the genitals, were thought to possess great power. Even the person of the king was thought to be of therapeutic importance, especially in the use of the "royal touch" for the treatment of scrofula (tuberculosis of the neck glands).

Surgery ultimately derived from Greek and Byzantine traditions, at least as transmitted by the Arabists and the schools of Salerno and Montpellier. In general, surgery was limited to wounds, fractures, dislocations, amputations, and the opening of abscesses and fistulas, conditions not easily ignored�at least, not for long. The procedures themselves were generally the most simple and direct possible: cut it off or out. The Arab tradition of using cautery in preference to ligation persisted. Complicated procedures for the most part were eschewed if possible, and the repair of hernias and the removal of bladder stones were uncommon. Suturing (often with human hair for thread) was known but rare. Considerable advances, however, were made in the treatment of eye diseases, as both cataract operations and the use of spectacles became more prevalent. Although medical treatment in the Middle Ages remains for us a bizarre combination of science and mysticism, this combination was not necessarily problematic to contemporary observers and derived ultimately from a redefinition of the classical conception of humors.

It didn't make much difference why there was an excess of a certain quality�or substance�in a portion of the body; it was more important to get rid of the imbalance. If an invocation or a purgative did the job, so much the better for not requiring anything more severe. But at times this would not be sufficient, and more drastic procedures were utilized. The most popular of these was bloodletting. Not unexpectedly, a physician might advise venesection but would rarely think of actually performing it. The surgeons who did this were thought unfit to receive any training beyond the obvious. Slowly, however, during the later medieval period, surgeons began to branch into two groups: those with greater education and those increasingly identified with the barbers. (It is difficult for us today to fathom the wide range of concerns allocated to barbers in the past�not just the care of locks and beard but also tooth-pulling, minor operations, the setting of bones and the like.) In France, the distinction between these two varieties of surgeons was given not only functional but legal definition.

If the pharmacy can be looked upon as the medieval workshop of the physician and of those whose vocations derived from the doctor, the public bath was the environment of the surgeon, although in the reliance of both upon diet a certain intermingling was obvious. There was much variety in the public baths. Many had tubs and vats, others often utilized steam therapeutically. Some baths were not restricted to one sex and gave bathing a notoriety which led to their being closed down. Often after a bath treatment, bloodletting would be performed, and the results were thought to be preferable to either being done separately. Albert S. Lyons A Brief History of Medicine A BRIEF HISTORY OF MEDICINE By Tim Lambert MEDICINE IN THE ANCIENT WORLD Medicine among Primitive Peoples The first evidence of surgery is skulls from the stone age. Some adults had holes cut in their skulls. At least sometimes people survived the 'operation' because the bone grew back. We do not know the purpose of the 'operation'. Perhaps it was performed on people with head injuries to release pressure on the brain. In the 19th and early 20th centuries anthropologists studied primitive societies.

Among them treatment for injury and sickness was a mixture of common sense and magic. People knew, of course, that falls cause broken bones and fire causes burns. Animal bites or human weapons cause wounds. Primitive people had simple treatments for these things e.g. Australian Aborigines covered broken arms in clay, which hardened in the hot sun. Cuts were covered with fat or clay and bound up with animal skins or bark. However primitive people had no idea what caused illness. They assumed it was caused by evil spirits or magic performed by an enemy. The 'cure' was magic to drive out the evil spirit or break the enemies spell. Ancient Egyptian Medicine In about 3000 BC the curtain rises on Egyptian civilization. In a civilized society some people did specialized jobs. One of these was the doctor. The first doctor known to history was Sekhet-eanach who 'healed the pharaoh's nostrils'. (We do not know what was wrong with them). The second doctor we know of was Imhotep (c. 2,600 BC) who was vizier or prime minister to the pharaoh. He was also a doctor and he was so famous that after his death he was worshiped as a god.

Much of Egyptian medicine still relied on magic. However at least they could keep written records of which treatments worked and which did not. In this way medicine could advance. The earliest known medical book is the Ebers Papyrus, which was written about 1500 BC. Egyptian doctors used a huge range of drugs obtained from herbs and minerals. They were drunk with wine or beer or sometimes mixed with dough to form a 'pill'. Egyptian doctors also used ointments for wounds and they treated chest complaints by getting the patient to inhale steam. The Egyptians believed that the human body was full of passages that acted like irrigation canals. The Egyptians knew that irrigation canals sometimes became blocked. They reasoned that if the passages in a human body became blocked it might cause illness. To open them Egyptians used laxatives and induced vomiting. However the Egyptians still believed that spells would help the sick and they carried amulets to ward off disease. Nevertheless they were beginning to seek a physical cause for illness. The Egyptians did have some knowledge of anatomy from making mummies. To embalm a dead body they first removed the principal organs, which would otherwise rot.

However Egyptian surgery was limited to such things as treating wounds and broken bones and dealing with boils and abscesses. The Egyptians used clamps, sutures and cauterization. They had surgical instruments like probes, saws, forceps, scalpels and scissors. They also knew that honey helped to prevent wounds becoming infected. (It is a natural antiseptic). They also dressed wounds with willow bark, which has the same effect. Moreover the Egyptians were clean people. They washed daily and changed their clothes regularly, which must have helped their health. Life in Egypt Ancient Greek Medicine The roots of modern medicine are in ancient Greece. On the one hand most Greeks believed in a god of healing called Asclepius. People who were ill made sacrifices or offerings to the god. They then slept overnight in his temple. They believed that the god would visit them in their sleep (i.e. in their dreams) and when they woke up they would be healed. At the same time Greek doctors developed a rational theory of disease and sought cures. However one did not replace the other. The cult of Asclepius and Greek medicine existed side by side. Medical schools were formed in Greece and in Greek colonies around the Mediterranean.

As early as 500 BC a man named Alcamaeon from Croton in Italy said that a body was healthy if it had the right balance of hot and cold, wet and dry. It the balance was upset the body grew ill. However the most famous Greek doctor is Hippocrates (C.460-377 BC). (Although historians now believe that he was much less famous in his own time that was once thought. It is believed that many of the medical books ascribed to him were actually written by other men). Hippocrates stressed that doctors should carefully observe the patients symptoms and take note of them. Hippocrates also rejected all magic and he believed in herbal remedies. A number of Greeks speculated that the human body was made up of elements. If they were properly balanced the person was healthy. However if they became unbalanced the person fell ill. Finally Aristotle (384-322 BC) thought the body was made up of four humors or liquids. They were phlegm, blood, yellow bile and black bile. If a person had too much of one humor they fell ill. For instance if a person had a fever he must have too much blood.

The treatment was to cut the patient and let him bleed. The Greeks also knew that diet and exercise and keeping clean were important for health. Later Alexander the Great conquered Egypt. In 332 BC he founded the city of Alexandria and a great medical school was established there. Doctors in Alexandria dissected human bodies and they gained a much better knowledge of anatomy. However little progress was made in understanding disease. Life in Greece Roman Medicine The Romans conquered Greece and afterwards doctors in the Roman Empire were often Greeks. Many of them were slaves. Doctors had low status in Rome. However the state paid public doctors to treat they poor. The Romans also had hospitals called valetudinaria for their wounded soldiers. Later in Roman times Galen (130-200 AD) became a famous doctor. At first he worked treating wounded gladiators. Then in 169 AD he was made doctor to Commodus, the Roman Emperor's son. Galen was also a writer and he wrote many books. Galen believed the theory of the four humors. He also believed in treating illness with opposites. So if a patient had a cold Galen gave him something hot like pepper. Galen was also interested in anatomy.

Unfortunately by his time dissecting human bodies was forbidden. So Galen had to dissect animal bodies including apes. However animal bodies are not the same as human bodies and so some of Galen's ideas were quite wrong. Unfortunately Galen was a very influential writer. For centuries his writings dominated medicine. In the first century BC a Roman named Varro suggested that tiny animals caused disease. They were carried through the air and entered the body through the nose or the mouth. Unfortunately with no microscopes there was no way of testing his theory. The Romans were also skilled engineers and they created a system of public health. The Romans noticed that people who lived near swamps often died of malaria. They did not know that mosquitoes in the swamps carried disease but they drained the swamps anyway. The Romans also knew that dirt encourages disease and they appreciated the importance of cleanliness. They built aqueducts to bring clean water into towns. They also knew that sewage encourages disease. The Romans built public lavatories in their towns. Streams running underneath them carried away sewage. MEDICINE IN THE MIDDLE AGES The eastern half of the Roman Empire continued and later Muslims took their knowledge of medicine from there.

In the 9th century a man named Hunain Ibn Ishaq traveled to Greece collecting Greek books. He then returned to Baghdad and translated them into Arabic. Later the same works were translated into Latin and passed back to western Europe. In the Middle Ages learning flourished in Europe. Greek and Roman books, which had been translated into Arabic were now translated into Latin. In the late 11th century a school of medicine was founded in Salerno in Italy. (Women were allowed to study there as well as men). In the 12th century another was founded at Montpellier. In the 13th century more were founded at Bologna, Padua and Paris. Furthermore many students studied medicine in European universities. Medicine became a profession again. However ordinary people could not afford doctors fees. Instead they saw 'wise men' or 'wise women', whose folk remedies were probably, at least sometimes, better than medicine! In the Middle Ages medicine was dominated by the ideas of Galen and the theory of the four humors. Medieval doctors were great believers in blood letting. Ill people were cut and allowed to bleed into a bowl. People believed that regular bleeding would keep you healthy. So monks were given regular blood letting sessions.

Medieval doctors also prescribed laxatives for purging. Enemas were given with a greased tube attached to a pigs bladder. Doctors also prescribed baths in scented water. They also used salves and ointments and not just for skin complaints. Doctors believed it was important when treating many illnesses to prevent heat or moisture escaping from the effected part of the body and they believed that ointments would do that. Medieval doctors also examined a patient's urine. The color, smell and even taste of urine were important. Astrology was also an important part of Medieval medicine. Doctors believed that people born under certain zodiacal signs were more susceptible to certain ailments. In the 13th century a new type of craftsmen emerged in towns. He (or she because not all were male) was the barber-surgeon. They cut hair, they pulled teeth and they performed simple operations such as amputations and setting broken bones. In the Middle Ages the church ran the only hospitals. (Although often the only thing they could do was offer food and shelter). In many towns monks and nuns cared for the sick as best they could.

Furthermore outside many towns were leper 'hospitals' (really just hostels as nothing could be done for the patients). Leprosy was a dreadful skin disease. Anyone who caught it was an outcast. They had to wear clothes that covered their whole body. They also had to ring a bell or a wooden clacker to warn people they were coming. Fortunately leprosy grew less common in the 15th century and it died out in Britain in the 16th century. In the Middle Ages only monasteries had sanitation. Streams provided clean water. Dirty water was used to clear toilets, which were in a separate room. Monks also had a room called a laver where they washed their hands before meals. However for most people sanitation was non-existent. In castles the toilet was simply a long passage built into the thickness of the walls. Often it emptied into the castle moat. Despite the lack of public health many towns had public bath-houses were you could pay to have a bath. From the mid-14th century the church allowed some dissections of human bodies at medical schools. However Galen's ideas continued to dominate medicine and surgery.

MEDICINE IN THE 16th CENTURY During the 16th century there were some improvements in medicine. However it remained basically the same as in the Middle Ages. Medicine was still dominated by the theory of the four humors. In 1546 a man Girolamo Fracastoro published a book called On Contagion. He suggested that infectious diseases were caused by 'disease seeds', which were carried by the wind or transmitted by touch. Unfortunately there was no way of testing his theory. In 1478 a book by the Roman doctor Celsus was printed. (The printing press made all books including medical ones much cheaper). The book by Celsus quickly became a standard textbook. However in the early 16th century a man named Theophrastus von Hohenheim (1493-1541) called himself Paracelsus (meaning beyond or surpassing Celsus). He denounced all medical teaching not based on experiment and experience. However traditional ideas on medicine held sway for long afterwards. However surgery did become a little more advanced in the 16th century.

Leonardo Da Vinci (1452-1519) dissected some human bodies and made accurate drawings of what he saw. However the greatest surgeon of the age was Andreas Vesalius (1514-1564). He did many dissections and realized that many of Galen's ideas were wrong. In 1543 he published a book called The Fabric of the Human Body. It contained accurate diagrams of a human body. Vesalius's great contribution was to base anatomy on observation not on the authority of writers like Galen. Another great surgeon was Ambroise Pare. In the 16th century surgeons put oil on wounds. However in 1536 during the siege of Turin Pare ran out of oil. He made a mixture of egg whites, rose oil and turpentine and discovered it worked better than oil. Pare also designed artificial limbs. In 1513 a man named Eucharius Roslin published a book about childbirth called Rosengarten. In 1540 an English translation called The Birth of Mankind was published. It became a standard text although midwives were women. Syphilis was common in the 16th century.

The standard treatment was mercury administered with a urethral syringe. In the 16th century syringes were also used to irrigate wounds with wine. MEDICINE IN THE 17TH CENTURY In the 17th century medicine continued to advance. In the early 17th century an Italian called Santorio invented the medical thermometer. In 1628 William Harvey published his discovery of how blood circulates around the body. Harvey realized that the heart is a pump. Each time it contracts it pumps out blood. The blood circulates around the body. Harvey then estimated how much blood was being pumped each time. Unfortunately in the 17th century medicine was still handicapped by wrong ideas about the human body. Most doctors still thought that there were four fluids or 'humors' in the body, blood, phlegm, yellow bile and black bile. Illness resulted when you had too much of one humor. Nevertheless during the 17th century a more scientific approach to medicine emerged and some doctors began to question traditional ideas. Apart from Harvey the most famous English doctor of the 17th century was Thomas Sydenham (1624-1689).

He is sometimes called the English Hippocrates because he emphasized the importance of carefully observing patients and their symptoms. In the 17th century medicine was helped by the microscope (invented at the end of the 16th century). Then in 1665 Robert Hooke was the first person to describe cells in his book Micrographia. Finally in 1683 Antoine van Leeuwenhock observed microorganisms. However he did not realise they caused disease. Meanwhile in 1661 Robert Boyle published the Skeptical Chemist, which laid the foundations of modern chemistry. In the early 17th century doctors also discovered how to treat malaria with bark from the cinchona tree (it contains quinine). The Chinese invented the toothbrush. (It was first mentioned in 1498). Toothbrushes arrived in Europe in the 17th century. In the late 17th century they became popular with the wealthy in England. MEDICINE IN THE 18TH CENTURY During the 18th century medicine made slow progress. Doctors still did not know what caused disease.

Some continued to believe in the four humors (although this theory declined during the 18th century). Other doctors thought disease was caused by 'miasmas' (odorless gases in the air). However surgery did make some progress. The famous 18th century surgeon John Hunter (1728-1793) is sometimes called the Father of Modern Surgery. He invented new procedures such as tracheotomy. Furthermore during the 18th century a number of hospitals were founded. In 1724 Guys Hospital was founded with a bequest from a merchant named Thomas Guy. St Georges was founded in 1733 and Middlesex Hospital in 1745. Hospitals were also founded in Bristol in 1733, York in 1740, Exeter in 1741 and Liverpool in 1745. The first hospital in America opened in Philadelphia in 1751. In the late 18th century and early 19th century dispensaries were founded in many towns. They were charities were the poor could obtain free medicines. In the 18th century many sailors suffered from scurvy (vitamin c deficiency).

However a Scottish surgeon named James Lind discovered that fresh fruit or lemon juice could cure or prevent scurvy. He published his findings in 1753 as A Treatise on the Scurvy. In 1792 Luigi Galvani discovered that frogs legs twitch if given an electric shock, showing that electricity plays a part in the nervous system. A major scourge of the 18th century was smallpox. However in 1796 a man named Edward Jenner (1749-1823) realized that milkmaids who caught cowpox were immune to smallpox. He invented vaccination. (Its name is derived from the Latin word for cow, Vacca). The patient was cut then matter from a cowpox pustule was introduced. The patient gained immunity to smallpox. Unfortunately nobody knew how vaccination worked. During the 18th century superstition declined. In 1700 many people believed that scrofula (a form of tubercular infection) could be healed by a monarch's touch. (Scrofula was called the kings evil).

Queen Anne (reigned 1702-1714) was the last British monarch to touch for scrofula. Despite the decline of superstition there were still many quacks in the 18th century. Limited medical knowledge meant many people were desperate for a cure. One of the most common treatments, for the wealthy, was bathing in or drinking spa water, which they believed could cure all kinds of illness. During the 18th century the mentally ill were not regarded as 'truly' human. It was thought that they did not have human feelings. They were therefore confined in chains. People paid to visit asylums and see the insane as if they were animals in a zoo. However in 1793 a doctor called Philippe Pinel argued that the insane should be released and treated humanely. As an experiment he was allowed to release some patients. The experiment worked and attitudes to the insane began to change. In 1792 a Frenchman named Dominique-Jean Larrey created the first ambulance service for wounded men. Life in the 18th Century MEDICINE IN THE 19TH CENTURY During the 19th century medicine made rapid progress.

In 1816 a man named Rene Laennec invented the stethoscope. At first he used a tube of paper. Later he used a wooden version. In 1822 a trapper named Alexis St Martin was shot in the stomach. The wound healed leaving a hole into his stomach. A doctor named William Beaumont found out how a stomach works by looking through the hole. During the 19th century there were several outbreaks of cholera in Britain. It struck in 1832, 1848, 1854 and 1866. During the 1854 epidemic John Snow (1813-1858) showed that cholera was transmitted by water. However doctors were not certain how. Later Louis Pasteur (1822-1895) proved that microscopic organisms caused disease. In the early 19th century many scientists believed in spontaneous generation i.e. that some living things spontaneously grew from non-living matter. In a series of experiments between 1857 and 1863 Pasteur proved this was not so.

Once doctors knew what caused disease they made rapid headway in finding cures or prevention. In 1880 Pasteur and a team of co-workers searched for a cure for chicken cholera. Pasteur and his team grew germs in a sterile broth. Pasteur told a co-worker to inject chickens with the germ culture. However the man forgot and went on holiday. The germs were left exposed to the air. Finally, when he returned the man injected chickens with the broth. However they did not die. So they were injected with a fresh culture. Still they did not die. Pasteur realized the germs that had been left exposed to the air had been weakened. When the chickens were injected with the weakened germs they had developed immunity to the disease. Pasteur and his team went on to create a vaccine for anthrax by keeping anthrax germs heated to 42-43 degrees centigrade for 8 days. In 1882 they created a vaccine for rabies. A co-worker dried the spines of rabbits that had contracted the disease in glass jars. Pasteur tried giving a series of injections made from the dried spines to animals to test the remedy.

Then, in 1885, Pasteur successfully used the vaccine on a boy who had been bitten by a rabid dog. Pasteur also invented a way of sterilizing liquids by heating them (called pasteurization). It was first used for wine (in 1864) and later for milk. Meanwhile In 1875 Robert Koch (1843-1910) isolated the germ that causes anthrax. In 1882 he isolated the germ that causes tuberculosis and in 1883 he isolated the germ that causes cholera in humans. Meanwhile the organism that causes leprosy was discovered in 1879. The germ that causes typhoid was isolated in 1880. The germ that causes diphtheria was discovered in 1882 by Edwin Klebs. In 1884 the germs that cause tetanus and pneumonia were both discovered. Immunization against diphtheria was invented in 1890. A vaccine for typhoid was invented in 1896. Surgery was greatly improved by the discovery of Anesthetics.

As early as 1799 the inventor Humphrey Davy (1778-1829) realized that inhaling ether relieved pain. Unfortunately decades passed before it was actually used in an operation in 1842. James Simpson (1811-1870), who was Professor of Midwifery at Edinburgh University, began using chloroform for operations in 1847. In 1884 cocaine was used as a local anesthetic. From 1905 Novocain was used. In 1865 Joseph Lister (1827-1912) discovered antiseptic surgery, which enabled surgeons to perform many more complicated operations. Lister prevented infection by spraying carbolic acid over the patient during surgery. German surgeons developed a better method. The surgeons hands and clothes were sterilized before the operation and surgical instruments were sterilized with super heated steam. Rubber gloves were first used in surgery in 1890. Anesthetics and antiseptics made surgery much safer. They allowed far more complicated operations. In 1851 Herman von Helmholtz invented the ophthalmoscope.

In 1895 x-rays were discovered by Wilhelm Roentgen. The same year aspirin was invented. Nursing was greatly improved by two nurses, Florence Nightingale (1820-1910) and Mary Seacole (1805-1881) who both nursed soldiers during the Crimean War 1853-56. Meanwhile in the 19th century several more hospitals were founded in London including Great Ormond Street Children's Hospital (1852). In 1864 Jean Henri Dunant founded the international Red Cross. During the 19th century the ancient practice of bloodletting declined. (It was still used in France, to treat pneumonia, until the 1920s). Life in the 19th Century MEDICINE IN THE 20TH CENTURY Medicine made huge advances in the 20th century. The first non-direct blood transfusion was made in 1914. Insulin was first used to treat a patient in 1922. The EEG machine was first used in 1929. Meanwhile many new drugs were developed.

In 1910 the discovered salvarsan, a drug used to treat syphilis was discovered. In 1935 prontosil was used to treat blood poisoning Later it was discovered that the active ingredient of the dye was a chemical called sulphonamide, which was derived from coal tar. As a result in the late 1930s a range of drugs derived from sulphonamide were developed. Antibiotics were discovered too. Penicillin was discovered in 1928 by Alexander Fleming but it was not widely used till after 1940. Another antibiotic, streptomycin was isolated in 1944. It was used to treat tuberculosis. They were followed by many others. Meanwhile the iron lung was invented in 1928 and in 1943 Willem Kolf built the first artificial kidney machine. (The first kidney transplant was in 1963). In Britain the health of ordinary people greatly improved when the National Health Service was founded in 1948. In 1953 Dr Jonas Salk announced he had a vaccine for poliomyelitis. A vaccine for measles was discovered in 1963.

Meanwhile surgery made great advances. The most difficult surgery was on the brain and the heart. Both of these developed rapidly in the 20th century. The external pacemaker was invented by a Canadian called John Hopps in 1950. The first implantable pacemaker was given to a patient in 1958. The first heart transplant was performed in 1967 by Christiaan Barnard. The first artificial heart was installed in 1982. The first heart and lung transplant was performed in 1987. The laser was invented in 1960. In 1964 it was used in eye surgery for the first time. Meanwhile the invention of fiber optics in the 1950s made possible the development of endoscopes in the 1960s. Treatment for infertility also improved in the late 20th century. The first test tube baby was born in 1978. In the late 20th century medicine continued to develop rapidly. In 1980 the World Health Organisation announced that smallpox had been eradicated. However in 1981 a terrible new disease called AIDS was isolated.

Meanwhile in 1975 Computerized Axial Scanning or CAT was introduced. In 1983 Magnetic Resonance Imaging or MRI was introduced. Synthetic skin was developed in 1986 and gene therapy was introduced in 1990. MEDICINE IN THE 21ST CENTURY In the early 21st century new types of transplant were performed. In 2005 the first face transplant took place. Then in 2011 the first leg transplant was carried out. Finally in 2012 the first womb transplant was carried out. What was the King's Evil? What was the King's Evil? Charles II touching a patient for the king's evil (scrofula) Image courtesy of Wellcome Library CC BY 4.0 When touching a monarch was believed to be a cure for illness. The King's Evil was the name given to scrofula, the swelling of the bones and lymphatic glands in the neck. Now recognised to be tuberculosis. From the time of Edward the Confessor, King of England 1003-1066, it was a superstitious belief that the disease could be cured by royal touch.

This belief of the curing touch of a monarch was to be found only in Britain and France. Succeeding Kings and Queens would hold ceremonies known as 'Touching for the King's Evil' where hundreds of people suffering from the disease would kneel before them and be touched by the monarch's hand. The ceremonies varied between the two countries. Some monarchs were hesitant to carry out the ceremony when plague and other diseases where ravaging the country, but they also realised the importance of the ceremony for the people and recognised that it could make them unpopular if they did not hold the ceremony. However, not all held the popular belief in the ceremony. James I of England believed it to be superstition, and during the Commonwealth period after the execution of Charles I, Parliament naturally thought it superstitious. On the restoration of the monarchy and its traditions, King Charles II restarted the ceremony. During his reign touched almost 100,000 people. On 6 July 1660 one of the ceremonies was witnessed by the diarist Evelyn .

"His Majesty sitting under his state [canopy] in the Banqueting-House, the chirurgeons [surgeons] caused the sick to be brought or led, up to the throne, where they kneeling, the King strokes their faces or cheeks with both his hands at once, at which instant a chaplain in his formalities says, 'He put his hands upon them, and he healed them.'" This is said to every one in particular. When they have been all touched, they come up again in the same order, and the other chaplain kneeling, and having angel [coin] gold strung on white ribbon on his arm, delivers them one by one to his Majesty, who puts them about the necks of the touched as they pass, while the first chaplain repeats, "That is the true light who came into the world." The ceremony concluded with a reading from the bible, prayers and a blessing. Then the King's hands were washed. Samuel Pepys, the great diarist, witnessed the ceremony a few months later on 13th April 1661 .

He wrote, "I went to the Banquethouse, and there saw the King heal, the first time that ever I saw him do it; which he did with great gravity, and it seemed to me to be an ugly office and a simple one." In 1712 Queen Anne touched a 2 year old boy. This was Samuel Johnson who later became famous for his dictionary. The practice in Britain stopped after Queen Anne, but continued in France until 1825.

Question: During the Middle Ages, which disease was known as 'King's Evil'as it was thought that only the touch of the King could cure it?
Answer: SCROFULA